Deadline Looms For States To Enroll Thousands In Health Plans

Aug 6, 2013

By October 1, states are supposed to have their health insurance exchanges up and running so they can enroll residents.

The exchanges are online insurance marketplaces for individuals and small businesses — where people can shop for a health plan.

Some people will pay out of pocket for their health coverage and others may get some help from the federal government to pay for their premiums.

Polls show that 40 percent of Americans do not know that the Affordable Care Act is in effect, and that percentage is higher for uninsured populations.

The states are spending $700 million to get the word out about their exchanges and to help people sign up for health insurance. Most of that money is coming from the federal government.

There’s also lots of confusion about premium prices. Some states are claiming that once Obamacare takes effect, insurance rates will go up, while other states, including New York, say their rates will do down.

What’s the truth?


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So where are we on setting up those health insurance exchanges? States have until October 1st to have these marketplaces up and running so that uninsured individuals and small businesses can shop around for a health plan. It's an important part of health care reform, which analysts say won't work unless a large number of the uninsured do sign up.

But it turns out with just months to go, people really don't even know what the exchanges are. So some states like Colorado are getting the word out.


UNIDENTIFIED MAN: At Connect for Health Colorado, you can shop, compare, pick and purchase the health plan that's right for you. So what actually happens when dozens of plans compete for your business?



YOUNG: And you seen images of Coloradans jumping around because they have just won. Nationwide, states will spend $700 million on aggressive ad campaigns, but 17 states have declined to set up their own exchanges. They're leaving the whole thing to Washington. What else do we need to know? Let's spend a few minutes with Kaiser Health News senior correspondent Julie Appleby.

And Julie, talk a bit first about these state ads. We played Oregon's last week, local musicians wandering around extolling the state's virtues. We understand none of the state ads even mention Obamacare.

JULIE APPLEBY: Well, a lot of them don't. I think that that reflects the politics around the law and the continuing debate over the law. But many of the states like Oregon, they're going for a humorous approach. They're trying to encourage people that, hey, this is new, it's out there. They want to get people to laugh. They want to get people to know that these marketplaces even exist. So that's the first step that they're doing.

So for example the Oregon ad, you've got the folk singer. In Colorado you've got the sports teams. And in places like Connecticut they're doing other things, as well. They handing out sunscreen packets on the beach that say, get covered, and it's got the new marketplace's name on it. And, you know, so they're really trying a bunch of different ways to get the word out about these markets.

YOUNG: Well, about what the market's names are. But as we just heard in Colorado, they're telling people a little bit more. What are the challenges? What kind of information do these ads have to get out?

APPLEBY: Well, I think like you mentioned, one of the biggest challenges is that a lot of folks don't even know this law is still in effect. In fact, there's - a poll came out recently that said 42 percent of Americans don't even know if the law is in effect, and about half of the folks don't have enough information, they say, to understand how it's going to affect them or their families. So that's the first challenge that they face.

So they're really just trying to get the word out that, hey, there's this health care law, it's in place, these new markets are opening, here's where you can go to find them.

YOUNG: Well, and we understand in the states where the federal government has taken over the health exchange marketplaces because the states aren't setting them up, there is almost going to be a campaign approach. They are going to literally knock on doors to get people to sign up.

APPLEBY: Right, I think that probably a lot of the states will be doing that. But, yes, there's 33 states where the federal government will be running all or part of the exchange. And so they've got a number of campaign efforts that they're going to be launching probably later this summer, maybe into September, where we're going to see more and more outreach and some of it does involve knocking door to door.

Some of it's going to involve a kiosk at a fair or some other kind of outreach, billboards, that kind of thing. The states are also doing these types of things with billboards and other advertising campaigns, and so I think we're going to see more and more of that as we get closer to that October 1st date, which is when the marketplaces open for enrollment.

YOUNG: There was some pushback on that. Didn't the president ask, I think it was the NFL or some sports league to help him get the word out, and they - it's too politically hot still for people.

APPLEBY: Again, it goes back to the politics. Kathleen Sebelius, the HHS secretary, said that she was talking with the NFL about doing some kind of outreach, some kind of announcement about the marketplaces and the health law. And think about it, I mean, this is a way to get young men and young women and other folks who are interested in football to know about these things. It seemed to make a lot of sense.

The opponents of the law, however, wrote to the NFL and said that this is still a really divisive issue and warned them that they probably shouldn't get involved, and actually the NFL did back away from that, and they're not going to be working on that.

That doesn't mean that the Obama administration has given up on sports teams necessarily, but they're also reaching out to Hollywood stars and other folks like that to try get some public service announcements, get some people involved in it that way.

YOUNG: It underscores the challenge, though. They're trying to get information, and meanwhile there are people who are discounting whether it's even valuable. And so they're trying to reach, we understand, young health people. The younger, healthier people signing up broaden the base that supports the whole system. They're targeting women who tend to make families' health care decisions.

They need to get the word out to some people that they're going to eligible for subsidies and to other people that if you've been rejected before, you may not be now.

APPLEBY: That's correct. Some of the ads are talking about that a lot. Remember, one of the big things that goes into effect in January is that insurers can no longer reject people who have a medical condition or charge them more because they're sick. So, some of the ads are focusing on this and saying hey, if you tried to get health insurance before, guess what, there's a whole new era, come sign up for this new marketplace.

And in a lot of ways the ad campaigns make sense because they are targeting those groups, but some analysts have said, well, you know, this could also be worrisome if all they attract are folks who have some kind of health condition and that they don't get the younger, healthier people to enroll, as well.

YOUNG: Well what you just said plays into what we want to take up after the break, which is approaching, which is, you know, what is true about people will see when they go to make these purchases at these marketplaces. You know, are the premiums going up or down? I don't want to go there yet, but the fact is that there's going to be a lot of different factors playing into this.

You mentioned one, that pre-existing conditions can't keep you from getting covered.

APPLEBY: That's correct, and this is part of the challenge of covering this as a reporter and also understanding it as a consumer is that there are a lot of changes, a lot of moving parts, and the premiums that are going to be charged in these exchanges are going to reflect that, to some extent.

YOUNG: Well, you know, insurers, too, have a big stake in this, and they are out also trying to get people to sign up.

APPLEBY: That's right. It's not just the states and the federal government that are going to be advertising. These insurers certainly have a big stake in it. A lot of them are already doing this. Blue Cross-Blue Shield Association, for example, has signed an agreement with Walgreens, and they're going to be linking to their - a website called Learn about Reform. They're going to be handing out brochures in Walgreens. Another major insurer, WellPoint, has signed a deal with Univision, and they are going to be advertising and providing information through Univision and also some links to their website that'll actually help people enroll in one of their plans.

YOUNG: OK, so if in several weeks you do now know that the exchanges are coming, and it's not because people haven't tried to tell you. That's Kaiser Health News senior correspondent Julie Appleby. We'll take a break, and on the other side, we'll ask what is true about these claims of premiums going up and down.


But first, a look at some of the other stories we're following today. It is the first day of testimony in the court martial of Army Major Nidal Hasan. He is the former Army psychiatrist charged with the attack at Fort Hood. Also voters go to the polls in New Jersey on August 13th in a special election for a U.S. Senate seat. One candidate has a daunting lead in that race in the polls, Newark Mayor Cory Booker. Those and other stories later today on ALL THINGS CONSIDERED. We're back in a minute with more of Robin's conversation, HERE AND NOW.


YOUNG: Welcome back to our conversation with Kaiser Health News senior correspondent Julie Appleby, everything you wanted to know about the health care exchanges. The deadline for states signing up uninsured in these marketplaces is October 1, it's looming, and yet a lot of people don't even know what it means.

And Julie, let's talk about the different things we're hearing about what it will cost. New York health officials claim their residents' health insurance premiums will drop by half after exchanges are set up. On the other end of the spectrum you have in Indiana officials there saying their premiums will increase by 72 percent once Obamacare, which even the president is now embracing, goes into effect. What's true?

APPLEBY: Well, you know, isn't this confusing? Premiums are going to go up; premiums are going to go down. What is going to be? The fact of the matter is it really depends, and that's a tough answer, maybe not one that folks want to hear, but it really depends where you live, what your age is, because they can vary the rates based on age, where you live, your family size and that type of thing. So it's going to vary on that.

And then you also have to keep in mind that there is no apples-to-apples comparison. So what are they going up to compare with? So current plans sold on the market are very different than what's going to be sold starting in January. They're just different coverage. They've got more benefits, that type of thing. So it's really difficult to compare the prices people pay now with the prices they're going to pay.

That said, we have seen some prices come out, and we have some examples of what it's going to cost.

YOUNG: Well, I want to hear those, but some of the things that make it different, now consumers can't be turned away or charged more because of risks, health problems, as we said before the break. They have maternity coverage. Women can't be charged more. So those things have to be factored in to what the premiums are going to be. But give some of what, you know, the things that you think are based in some sort of reality, because again, state regulators are picking and choosing what they want to factor into their estimates of what premiums will be.

APPLEBY: Well, insurers are sitting and looking at the marketplace, and they're trying to make their best guess on who's going to sign up, how healthy are they going to be and what are their expected claims cost. So really insurers are making their best guess about that. And so that's how they price these things. What do we think it's going to cost us?

And yes, they're going to cover more benefits now. They've got to cover hospitalization, for example, prescription drugs, maternity care, things that today in the individual market aren't necessarily covered in policies. And they also cannot turn people away who are sick or charge them more, that type of thing.

There's also limits on the amount that consumers might have to pay out of pocket. For example, an individual plan can't change any more than $6,350 for out of pocket, that would be your deductibles, your co-pays for the year. And a family plan would be about 12,700. And that sounds like a lot of money, but on the individual market today, a lot of people have deductibles and co-pays and things like that that are much higher than that.

It's not unusual to see a $20,000 out-of-pocket maximum, for example. So those factors all have to go into, well, how much is this going to cost.

YOUNG: Right, so in other words a premium may go down on a plan, but your deductibles go sky high. But what is true about, for instance, New York's claim, other states as well, saying their premiums will go down?

APPLEBY: Well, in New York it's a little bit of an unusual situation because New York had some longstanding laws that, for example, said insurers have to sell to everybody even if they're sick, and they charge everybody the same amount in that state. But the state does not have a requirement that everybody buy insurance.

So over time it's been the sicker or the older or the less healthy people who have bought coverage. So the prices have gone up. So a lot of policy experts expected the premiums to go down in New York for that reason. It was already one of the most expensive states in the country. It's - so it's not entirely surprising that the rates in comparison are going to go down.

But again, you might be comparing a little bit of apples to apples and oranges.

YOUNG: Well, what about the overarching thought that the competition alone will drive the prices down?

APPLEBY: That is the theory, that competition among insurers is going to reduce prices, and I think we've seen a little bit of an example of that. It may still be too early to tell, but in the District of Columbia and in Oregon, several insurers actually reduced their premiums after they initially filed their proposals when they saw what the other rival insurers were going to be charging.

They said hey, wait a minute, we want to lower our premiums a little bit, and so we've seen some of that...

YOUNG: So the marketplace worked.

APPLEBY: It worked in those situations, yes.

YOUNG: But on the other hand, you know, Mississippi had trouble getting some insurers to sell on the exchange to residents in poorer areas.

APPLEBY: That's right, they had 36 counties at one point that were not going to have any insurers offering coverage through these new marketplaces, and that was very worrisome. I think the state and other folks talked a little bit more with the insurers, and they did eventually get one insurer to say yeah, you know what, we've cover the whole state. So they do now have at least one plan available in those 36 counties, as well as the rest of the state.

YOUNG: But what is - what should people know? We've written an article, and we should post, the five things that people should know when they go to buy on these exchanges. Tell us more about what they should know. We've talked about how you really can't compare to your old plan. If for instance, a new plan has so many more benefits than your old plan, you might have to pay a little more.

But what are some things that people should know as they go in?

APPLEBY: Well, remember, these marketplaces are for individuals who don't get coverage through their jobs, for the most part, and for small businesses, which are defined as companies with 50 or fewer workers. So those are the main people that are going to be shopping in these markets. And there's about 14 million people right now who buy their own coverage, and they expect about another seven million or so to sign up next year through these marketplaces for - so for many people who have job-based insurance, these marketplaces really aren't going to make a difference for them because they're just going to keep getting it through their jobs.

But for people who buy their own coverage, you've got to remember prices are going to vary based on where you live, your age, the type of plan you choose. Subsidies are going to be available for many people. Of those seven million they expect to enroll next year, about six million are expected to be eligible for subsidies.

YOUNG: And remind us, who is that that's eligible?

APPLEBY: The subsidies are going to go to folks who earn between 100 percent and 400 percent of the federal poverty level, which is about $11,500 a year to about $46,000 a year for an individual. And they will be sliding scale subsidies. So the subsidies will be more generous on the lower end of the scale and less generous as you earn more money.

YOUNG: So all this time, and the fact is it's not going to affect that many people, but it needs at least a certain amount of people to sign up to make the whole system work. Is it far to say there's kind of an overarching truth that generally younger people, healthy younger people who have high-deductible coverage now may see a little bit of increase in their premiums, but older, less healthy people may see their rates go down a little bit, just sort of an overarching thought?

APPLEBY: That's correct, that's correct, because younger people who are buying higher-deductible policies on the market now probably will see a premium increase because they're going to have lower deductibles, they're going to have more coverage, and there's this thing in the law that requires insurers to charge older folks no more than three times the amount they charge younger folks.

So for the older folks, this is possibly going to lower their premiums, but for younger people, it could raise it.

YOUNG: And what's the next date after October 1?

APPLEBY: Well, January 1 is when all these policies will go into effect, and then you have open enrollment through the end of March. So people can sign up for one of these plans starting in October all the way through to the end of March, and then they go into effect, and you can carry them for a year, and you'll be renewing them at the end of the year, end of 2014.

YOUNG: Julie Appleby, senior correspondent for Kaiser Health News, with the first of many primers I'm sure we're going to have as we look ahead to new aspects of Obamacare that are quickly coming into place. Julie, thanks so much.

APPLEBY: Thank you for having me.

HOBSON: And a quick bit of news, Robin, from the world of public broadcasting today. PBS has announced that Gwen Ifill and Judy Woodruff will be the co-anchors and managing editors of "The PBS NewsHour" starting in September instead of the rotating host format that they have used for a while.

YOUNG: Terrific news for them. Thank you, Jeremy.

HOBSON: And the news is next, HERE AND NOW. Transcript provided by NPR, Copyright NPR.